why and how can people abuse the ER?

Not_A_Hat_Person, RN · Feb 8, 2012

Also, why don't people just go to their clinic, urgent care, minute clinic...why ER for a minor ailment? Isn't it more expensive for them to go to the ER?

I used to live in Boston, a city with a huge shortage of PCPs, and no urgent care centers or Minute Clinics. If you didn't want to wait at least 3 weeks to see your PCP, or you didn't have a PCP, the ER was your only option. When I was between PCPs, I had to go to the ER for a strep test.

MN-Nurse, ASN, RN · Feb 8, 2012

MN-Nurse - people were abusing the ER long before GWB was in office and will continue to do so - as you can see - long after he is gone.

Sure, but he was the only one dim enough to actually come out and say that the ER is a perfectly good option.

SpaceCoastRN · Feb 8, 2012

What you do is show up and give a fake SS# and a fake address and you'll get free treatment and never get a bill.

The awesome thing about that is we had someone do the exact same thing you listed recently. When our registration dept. does there thing it includes scanning a photo ID into the system which the patient provided (drivers license). They gave a fake SSN with that, the computer kept rejecting the SSN as it belongs to another patient that uses our facility. When they were up for discharge the local PD was waiting outside with felony arrest for identity theft amongst several already pending charges. So sometimes karma works out.

6spdftwtm · Feb 8, 2012

I've saw the same thing once. Ms. X came in repetitively, over and over and over again, but instead of just sticking to one identiy, she'd alternate between two of them. Finally, when someone caught onto what she was doing, they discovered she had racked up like $30,000 in unpaid ER bills (not even $5 paid) under her false identity.

My absolute FAVORITE clients of all times were the narcotic seekers. It just gets really hilarious, sometimes. And I am only a LITTLE sorry to say that I am jaded because you start to noticed patterns after being in the ER for 5 or so years. Namely, if you are allergic to codeine, ibuprofen, naproxen, toradol, ultram, Darvocet, Nubain and you calmly tell me your pain scale is a "100/10" WITHOUT bones protruding from your body somewhere or AT LEAST some vital sign abnormal, all the while smiling and laughing and chit-chatting on the phone with your buddies while I'm trying to triage you....yep...I may have formed a label about you in my mind just now. ESPECIALLY if you ask me not to dilute the Dilaudid and "push it fast." ORR if you send me on a wild goose-chase to ask the doctor for a different prescription when you see the RX you are getting is for Ultram or Motrin and the doc looks up on the prescription monitoring website and sees that you have been to 5 ER's locally in the past week and have procured a narcotic prescription from each one of them. It's always a little bizarre to me how the ones who are the sickest are just glad to get the care and the ones who are there for trivial, piddly crap yell and scream and throw the biggest fits for having to wait or not getting the drug they want when they want it.

There are actually "how-to" guides on the internet about how to fake a renal stone. Search for it in Yahoo and see for yourself. Mighty impressive.

Of course, northeast TN/southwest VA is notorious for narcotic abuse, anyhow. Thankfully, in TN it is now completely illegal to doctor-shop and is completely at the practitioner's discretion to call the PD and have them arrested....seen it done a time or two and it is VERY liberating.

Sorry....end rant.

Love my job!

Late,

Trav

DixieRedHead, ASN, RN · Feb 8, 2012

From working in the ER many years I too became jaded and certainly resented the drug seekers, ER abusers, and those who came in to avoid paying.

There are however a few things that we need reminding of.

1. If you come to the ER, or are in the hospital for that matter, and have no insurance, most hospitals cut the bill in half to start with.

2. Every item, and I mean every item is negotiable.

3. If they ask, if they just ask, in the finance office the bill will often be cut further.

I4. If they pay five bucks a month, the hospital has to accept it.

But here was the real kicker for me.

Do you like working in the ER? Do you really. On any given day, take a look around you and count your coworkers. Now figure out how many of them would be there if all you saw was REAL emergencies. Would YOU be there?

Medic2RN, BSN, RN, EMT-P · Feb 8, 2012

Do you like working in the ER? Do you really. On any given day, take a look around you and count your coworkers. Now figure out how many of them would be there if all you saw was REAL emergencies. Would YOU be there?

I understand what you are saying, however, there comes a time when something has to give.

Where do hospitals cut costs?

Employees - just like any other company. In my hospital there has been approximately 100 hospital employees laid off, a whole wing closed because all the nurses were let go, our shift differential was decreased and a few hours eliminated, certification pay eliminated, critical care pay - gone, and our staffing matrix changed to reduce staffing meaning a cut in hours. With all of these changes, we are still expected to function as "normal".

As I said, I understand, but when it starts affecting a nurse's paycheck, well....you do grow a bit jaded.

TheSquire, DNP, APRN, NP · Feb 9, 2012

I also have to tell you guys it is REALLY not all that bad. It is ONLY going to get worst with President Obama's health care bill. Here in Quebec, where we have public healthcare that we pay VERY dearly for, people use the ED for everything from a daycare center for their elderly parents to getting a doctor's note when they are hungover and don't want to go to work.

...and how is that different from what we experience now?

uRNmyway, ASN, RN · Feb 9, 2012

...and how is that different from what we experience now?

Well instead of being people on Medicare/Medicaid who do this, or the scammers who wont pay, it will be every Tom, Dick and Harry because everyone will have free healthcare

TheSquire, DNP, APRN, NP · Feb 9, 2012

Well instead of being people on Medicare/Medicaid who do this, or the scammers who wont pay, it will be every Tom, Dick and Harry because everyone will have free healthcare

Again, you fail to state how it'll be different than it is now. I see every Tom, Dick, and Harry in the ED already.

Altra, BSN, RN · Feb 9, 2012

I found out that some states, maybe all (not sure about which ones) have emergency treatment funds. Basically, hospitals cannot refuse to care for someone in an emergency situation, whether its a GSW or active labor, because of lack of insurance or inability to pay. There are certain eligibility conditions, you have to have below a certain income, etc.. But people who cannot pay for emergency care will not necessarily go home to a huge bill.
I also have to tell you guys it is REALLY not all that bad. It is ONLY going to get worst with President Obama's health care bill. Here in Quebec, where we have public healthcare that we pay VERY dearly for, people use the ED for everything from a daycare center for their elderly parents to getting a doctor's note when they are hungover and don't want to go to work. So good luck to all of you ED employees, I really hope it doesn't get as bad there as it is here!

From your post I surmise that you are in Canada. Some clarification:

No one in the US is turned away from a medical screening exam at an emergency department. This is a requirement of a federal law commonly referred to as EMTALA. (see post #2 above)

Few hospitals deny treatment for non-emergent complaints, even though they have a legal right to: it's simply too much liability risk, and a PR nightmare.

And so ERs in the US do indeed get used as elder care, a source of work excuses, a place to sleep off a bender, and a way to avoid shelling out 5 bucks or less for a bottle of Tylenol or a pregnancy test.

I personally am starting to conclude that there is something in the water here that makes us Americans unable to plan ahead for even minor inconveniences/"emergencies" -- as a whole, our culture displays a stunning lack of ability to cope. And unfortunately, I don't see that changing, regardless of what, if anything, happens to change the financial structure of the health care industry.

Some US states do have pools of funds to reimburse hospitals for care provided to the uninsured. And hospitals do have some ability to legitimately write off charity care when filing taxes. But this amounts to pennies on the dollar. Just one uninsured patient's catastrophic illness/surgical emergency/trauma quickly leads to a 6-figure cost of care.

TheSquire, DNP, APRN, NP · Feb 10, 2012

I personally am starting to conclude that there is something in the water here that makes us Americans unable to plan ahead for even minor inconveniences/"emergencies" -- as a whole, our culture displays a stunning lack of ability to cope. And unfortunately, I don't see that changing, regardless of what, if anything, happens to change the financial structure of the health care industry.
Having done a review of the literature on this topic once upon a time, I can say that it's not just in the water in the US, it's everywhere - nonemergent/nonurgent use of the ED is an international issue.

Editorial Team / Moderator · Feb 11, 2012

Again, you fail to state how it'll be different than it is now. I see every Tom, Dick, and Harry in the ED already.

Yep, I have to agree with you, TheSquire. Working in an Army ED, which is a little microcosm of universal healthcare, is not so different than a civilian ED at all. Been in both.